What is the importance of a good night’s sleep? More and more evidence has built over the past few years that have indicated that not having a good night’s sleep results in much more than being a little groggy the next day. Not getting enough sleep can negatively impact your immune system, your cardiovascular system, your ability to maintain a healthy weight and your psychological well-being. There also continues to be mounting evidence that pain and sleep are closely related. New incidents and exacerbations of pain can be predicted from onsets of sleep impairments. Once someone becomes sleep deprived and in pain, it begins a vicious repetitive cycle. We can’t sleep because we are in pain, and we are in worse pain because we can’t get the sleep we need.
Does poor sleep cause pain and vice versa or are they simply conditions that are related to one another? It is obvious that pain could trigger poor sleep. If we are unable to be comfortable at night, we will have a harder time getting to sleep or staying asleep. What may not be so obvious is that a lack of sleep can contribute to, or exacerbate pain. The opposite can be true as well. Our bodies need sleep every night to renew not only our musculoskeletal system but also our neurophysiologic system. In simpler terms, our brains use the time during sleep to reorganize and repair important neural connections.
As we further understand pain science, we know that pain is caused by more than just mechanical disruptions or aggravation in our musculoskeletal system. The parts of our brain that govern our pain response are impacted by past experiences – fear, anxiety and depression among other stimuli. It is important to get a good night’s sleep for our brains to appropriately deal with these conditions. The National Sleep Foundation and the CDC recommend 7 to 9 hours of sleep per night to get the appropriate amount of rest for our bodies and our brains.
In today’s day and age, there are many distractions from getting the appropriate amount of sleep needed. There is also not enough education in regards to the numerous negative impacts of too little sleep. Physical therapists frequently see patients in chronic pain and should use this opportunity to questions their patients about their sleep habits, educate them on how they can improve them and why it is important. Many of the recommendations for improving our sleep seem like common sense, but are in general poorly practiced in today’s society.
One of the most important ways we can improve our sleep is develop a regular pattern or routine for going to bed. This includes going to bed at roughly the same time each night and spending the last 30 minutes before bed performing a similar routine – brushing teeth, taking a shower, changing in to pajamas, reading a book, etc.. These stimuli help the body and ours brains learn to expect sleep and condition ourselves to prepare for it. The minutes leading up to sleep should involve quiet and relaxing activities. Meditations or other relaxation techniques can help relax the nervous system, help with pain and prepare your body for sleep.
Caffeine should be extremely limited or avoided afternoon, and very heavy, fatty or sugary foods right before bed can have a negative impact. Alcohol may help in the initial process of falling to sleep, but excessive drinking can negatively impact the quality of our sleep and cause us to wakes frequently throughout the night.
We should ensure we are creating an environment in our bedrooms that is conducive to good sleep. Reducing or eliminating screen time 30 minutes before bed, reducing light and noise in the bedroom as much as possible and keeping the room slightly cooler than normal will promote better sleep. In order to reduce our core temperature further, a warm shower before bedtime will cause our body to react by cooling our core body temperature.
Physical Therapists should utilize appropriate methods to assist patients with their pain. While the more traditional methods such as exercise, activity modification and manual therapy are frequently employed by physical therapists, to get the best outcomes we should be using additional educational opportunities such as stress management techniques, pain neuroscience education and sleep hygiene advice.
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